E2142. CT-Scan Guided Intraorbital Amphotericin Injection in Post COVID-19 Orbital Mucormycosis: A Case-Control Study
  1. Mahsa Alborzi Avanaki ; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences
  2. Farzad Pakdel ; Farabi Hospital, Tehran University of Medical Sciences
  3. Alireza Abrishami ; Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences
  4. Hossein Ghanaati ; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences
  5. Mohammadreza Salehi; Imam Khomeini Hospital, Tehran University of Medical Sciences
  6. Sadegh Khodavaisy ; Tehran University of Medical Sciences
Sinu-orbital mucormycosis (SOM) as a fulminant, opportunistic, and life-threatening fungal infection that occurred with a high incidence following the COVID-19 pandemic. This condition is considered as an indication for exenteration in patients with apical or extensive orbital involvement. As an alternative method, we performed CT-guided intraorbital injection of amphotericin-B. We aim to report this novel technique in comparison with blind/conventional apical injection.

Materials and Methods:
This case-control study was conducted on thirty patients with COVID-19-associated SOM from September to December 2021. All patients underwent intraorbital injection of amphotericin-B in two groups; fifteen cases as study/case group under CT-guidance were compared to fifteen randomly selected controls for conventional retro bulbar injection. Patient characteristics, clinical data, imaging findings, and complications were recorded and analyzed before and after the procedure.

The mean age of patients was 51.8 ± 11.7 (range: 28 - 73) and 23 patients were male [76.7%, case: 11 and control: 12]. Mean of total injection and CT-guided injection were 5.8 ± 4 (range: 0 - 14) and 1.8 ± 0.8(range: 1 - 3), respectively. The mean of preorbital injection abscess volume was 4346 ± 3107 mm3 (range: 1481 - 13184) and post-injection mean volume was 2629 ± 3156 mm3 (range: 385 - 12533.1) (p = 0.005). Extra-ocular movement and visual acuity improvement were achieved in 10 (62.5%) and 2 (12.5%) of the study group, respectively. Regarding complications, orbital exenteration in study and control groups were 1 (6.3%) and 11 (78.6%), respectively (p < 0.001). Complete remission was achieved in 1/15 (6.7%) and partial remission in other patients of study group [14/15, 93.3%]. Out of the 7 expired patients, 5 (35.7%) were in control and 2 (13.3%) in study group (p = 0.13).

CT-Scan Guided Intraorbital injection of amphotericin-B in post COVID-19 orbital mucormycosi can be considered as an effective method that may significantly decrease exenteration without increasing mortality of patients.